The need for palliative care is growing along with a rapidly aging population. To meet this need, the American Association of Colleges of Nursing developed palliative care competencies that all nurses should achieve before graduation. Many of these competencies rely on direct experience in caring for patients facing serious illness, leading to an increased emphasis on experiential learning in nursing curricula. Experiential learning is the process of creating knowledge through transformative experiences outside the traditional classroom setting. The Comfort Shawl Project is a service learning project that provides senior nursing students with a yearlong immersion in palliative care. Experiential learning activities include attending the interdisciplinary palliative care team meeting, gifting handcrafted shawls to patients, writing reflections, participating in extracurricular events, and sharing the impact of the project through written papers and presentations. The project has been successful in helping nursing students achieve palliative care competencies, including communicating effectively and compassionately with patients and families and recognizing one’s own beliefs about serious illness and death. This project addresses the need to achieve primary palliative care competencies for nursing students. Clinical experiences in palliative care are vital to supplementing didactic learning, and this project could be replicated in a variety of academic settings.
Abstract Objective Low circulating serum levels of 25‐hydroxyvitamin D (referred to hereafter as vitamin D) have been correlated with many health conditions, including chronic pain. Recent clinical practice guidelines define vitamin D levels <20 ng/ml as deficient and levels of 21–29 ng/ml as insufficient . Vitamin D insufficiency, including the most severe levels of deficiency, is more prevalent in black Americans. Ethnic and race group differences have been reported in both clinical and experimental pain, with black Americans reporting increased pain. The purpose of this study was to examine whether variations in vitamin D levels contribute to race differences in knee osteoarthritis pain. Methods The sample consisted of 94 participants (74% women), including 45 blacks and 49 whites with symptomatic knee osteoarthritis. Their average age was 55.8 years (range 45–71 years). Participants completed a questionnaire on knee osteoarthritis symptoms and underwent quantitative sensory testing, including measures of sensitivity to heat‐induced and mechanically induced pain. Results Blacks had significantly lower levels of vitamin D compared to whites, demonstrated greater clinical pain, and showed greater sensitivity to heat‐induced and mechanically induced pain. Low levels of vitamin D predicted increased experimental pain sensitivity, but did not predict self‐reported clinical pain. Group differences in vitamin D levels significantly predicted group differences in heat pain and pressure pain thresholds at the index knee and ipsilateral forearm. Conclusion These data demonstrate that race differences in experimental pain are mediated by differences in the vitamin D level. Vitamin D deficiency may be a risk factor for increased knee osteoarthritis pain in black Americans.
Primary palliative care is a core component of nursing practice for which all students must receive formal education. Through competency-based education, nursing students develop the knowledge, attitudes, and skills to deliver quality primary palliative care before they transition to practice. Nurse educators in academic and practice settings should use reliable and valid means to evaluate student learning across cognitive, affective, and psychomotor domains. Expert faculty conducted a literature review to identify published instruments that evaluate primary palliative care student learning outcomes. Selected articles were required to include instrument reliability, validity, or both. The literature search yielded 20 articles that report on the development and testing of 21 instruments. Findings are organized into 3 learning domains that encompass 5 outcomes. Four instruments assess knowledge within the cognitive domain. In the affective domain, 3 instruments assess attitudes about caring for seriously ill or dying patients, 7 assess attitudes about death, and 5 assess self-efficacy. Competence and competency are evaluated in the psychomotor domain with 4 tools. Instrument implementation considerations within each domain are discussed. Faculty are encouraged to use robust evaluation measures such as those identified in the literature review to measure primary palliative care learning outcomes within a competency-based education framework.
Decision Making in Gerontological Nursing provides practicing nurses with assessment and intervention strategies in the clinical setting. This practical text enhances decision-making skills through pertinent principles of anatomy and physiology, a patient's history, clinical manifestations, interventions and patient teaching. Divided into physical, psychosocial and functional disorders, this book focuses on the conditions commonly seen in elderly people. Other features of the text include: decision trees which present plans of care while taking into consideration possible alternatives and complications that could influence the outcome; coverage of such problems as sleep and rest disturbances, adaptational problems, emergency situations, medications and spiritual care; and cross-referencing of each disorder in other sections for complete coverage.
